Pablo Martinez Monsivais, Associated Press "Every once in a while a moment comes where you have a chance to vindicate all those best hopes that you had about yourself, about this country," President Barack Obama told House Democrats on Capitol Hill Saturday. "This is one of those moments." By David M. Herszenhorn and Robert Pear

WASHINGTON, D.C. -- President Barack Obama and House Democratic leaders on Saturday closed in on the votes needed to pass landmark health care legislation, with the outcome hinging on their efforts to placate a handful of lawmakers who wanted the bill to include tighter limits on insurance coverage for abortions.

Obama, in an emotional address at the Capitol, exhorted rank-and-file House Democrats to approve the bill, telling them they were on the edge of making history with the decisive vote scheduled for today.

"Every once in a while a moment comes where you have a chance to vindicate all those best hopes that you had about yourself, about this country," he said. "This is one of those moments."

The president declared: "We have been debating health care for decades. It has now been debated for a year. It is in your hands."

With the ground shifting by the hour, House Democratic leaders dropped a plan to approve the Senate health bill without taking a direct vote on it. That proposed maneuver had outraged Republicans and caused consternation among some Democrats.

Thousands of opponents of the bill circled the Capitol chanting angry slogans. Some of the anger was directed at black lawmakers, including several who said that some demonstrators had hurled racial insults at them.

Speaker Nancy Pelosi refused to give abortion opponents a separate vote on that issue, a sign of her confidence that she could clinch the votes without further changes to the bill.

Democrats said they would vote today on the Senate bill and then on revisions to it included in a budget reconciliation measure.

Democrats said the outcome would be the same: the Senate bill would be sent to Obama, who would sign it into law, and the reconciliation bill would go to the Senate, which could take it up within days.

At the rally with Obama, Senate Majority Leader Harry Reid of Nevada assured House Democrats that their Senate colleagues would act quickly on the reconciliation bill, including final revisions to the health care measure. "I have the commitments of a significant majority of the United States Senate to make that good law even better," he said.

As Obama concluded his remarks, Pelosi appeared to be within eight votes of the 216 she needs to approve the bill, with 19 Democrats still uncommitted. Republicans are all expected to oppose the bill.

The House Republican leader, John Boehner of West Chester, said the GOP could still prevail. "The American people are making their voices heard, here on Capitol Hill and across America," he said. "It's time for Washington Democrats to listen."

In his speech, Obama drew chortles from lawmakers -- and laughed at himself -- when he suggested that perhaps Republicans were hoping to spare Democrats political pain by blocking the bill.

"Mitch McConnell, John Boehner, Karl Rove, they are all warning you of the horrendous impact if you support this legislation," the president said, referring to the Senate and House Republican leaders and a top adviser to former President George W. Bush.

"Now, it could be that they are suddenly having a change of heart and they are deeply concerned about their Democratic friends; they are giving you the best possible advice in order to ensure that Nancy Pelosi remains speaker and Harry Reid remains leader and all of you keep your seats," Obama joked. "That's a possibility."

He continued, "But it may also be possible that they realize that after health reform passes and I sign that legislation into law, it's going to be a little harder to mischaracterize what this legislation has been all about."

Pelosi expressed total confidence. "We are on the verge of making great history for the American people," she said.

The speaker on Saturday rejected a proposal by Rep. Bart Stupak, Democrat of Michigan, a leader of the abortion opponents, to revise the abortion provisions after the bill was adopted, a step that is typically used to make minor or technical changes and that requires approval of both the House and the Senate.

Instead, Democratic officials said they were pursuing the idea of promising that Obama would issue an executive order prohibiting the use of taxpayer money for abortions. They said that approach would not mollify Stupak but could win the support of others still undecided because of their views on abortion.

Five Democrats with concerns about abortion attended a late-night meeting at the White House to discuss the proposed order.

Pelosi said she would not allow separate votes on abortion or other controversial issues. "Not on abortion, not on public option, not on single-payer, not on anything," she said.

Behind the scenes, Pelosi was working aggressively to address the concerns of anti-abortion Democrats.----

The official action on Saturday was in the House Rules Committee, which labored to set the formal terms of the debate for Sunday's showdown.

Before Democrats decided to take a direct vote on the Senate health care bill, Rep. Joe L. Barton, Republican of Texas, described the plans to approve it without a direct vote as "a sleight-of-hand subterfuge" that would allow lawmakers to avoid accountability.

"This process corrupts and prostitutes the system" and could "unleash a cultural war" over the legislation, Barton said.

Democrats, however, tried to keep the focus on the substance of the health care legislation, which seeks to extend coverage to 32 million uninsured Americans.

"We are on the verge of taking a decisive step to providing access to all Americans, to affordable quality health care," said Rep. Henry A. Waxman, Democrat of California and chairman of the Energy and Commerce Committee. "If we do nothing, the system will go bankrupt, premiums will keep skyrocketing and benefits will keep getting slashed."

The legislation would cost $940 billion over 10 years, according to the Congressional Budget Office, with the expense more than offset by revenues from new taxes, fees and reductions in spending on Medicare and other government programs. With those changes, the bill would reduce future deficits by $138 billion over that time period, the budget office estimate found.

At a news conference on Saturday, 13 House Republican freshmen assailed the measure. "Let's kill this bill," said Rep. Cynthia M. Lummis, Republican of Wyoming.

The late-hour maneuvering on abortion mirrored a similar process in November before the House adopted its version of the health care legislation.

In November, Stupak succeeded in winning approval of tight limits on insurance coverage of abortions in the House bill. The current package now includes language from the bill passed in the Senate and negotiated by two Democrats, Sens. Bob Casey of Pennsylvania and Ben Nelson of Nebraska, who have built up solid credentials in their political careers as abortion opponents.

Once again, Stupak was opposed by a group of lawmakers who favor abortion rights, led by Rep. Diana DeGette, Democrat of Colorado. And once again, at the center of the storm was Pelosi, the first woman to serve as House speaker, who is a champion of abortion rights.

The abortion issue has divided Roman Catholic groups in the United States, with the U.S. Conference of Catholic Bishops opposing the bill and other organizations, including the Catholic Health Association and a coalition of nuns from leading religious orders, favoring it.

Stupak and many of the lawmakers insisting on the tighter restrictions are Catholic, as is Pelosi, and all have cited their faith in justifying their position on the legislation.

In a sign of the emotion around the issue, Rep. Dale E. Kildee, Democrat of Michigan, who is Catholic and opposes abortion, announced his support for the legislation in a statement noting that he had once studied for the priesthood. He said he had consulted his priest and concluded that the abortion restrictions in the Senate bill were sufficient.

Democratic leaders said they hoped an executive order by Obama would clarify that the legislation was not intended to change existing federal law and policy that generally bar the use of taxpayer money for abortions.

"That is very good if the president does that," said Rep. Lynn Woolsey, Democrat of California, and co-chairwoman of the Congressional Progressive Caucus. "He will clear it up. The Senate bill does not allow federal funds to be used for abortion."

But Rep. Anh Cao of Louisiana, the only Republican who voted for the bill in November, said he could not support the current measure because of its "expansion of abortion, an absolute moral evil."

Democratic lawmakers and top aides have been working around the clock trying to address flare-ups over elements of the bill. They said that they had worked out an agreement to resolve one of the last remaining issues: a dispute over geographic disparities in Medicare payments.

The agreement could lead to higher payments to doctors and hospitals in states like Iowa, Minnesota, Oregon, Washington and Wisconsin, where Medicare rates are relatively low but studies suggest that the quality of care is high.

Kathleen Sebelius, the secretary of health and human services, sent a letter to Congress saying she would commission studies by the National Academy of Sciences to investigate the issue and recommend solutions.

"The current geographic variation in Medicare reimbursement rates is inequitable," Sebelius said.

Outside the Capitol, several House members said there was an ugly tone to comments made by some demonstrators against three black lawmakers: Reps. Andre Carson of Indiana, Emanuel Cleaver II of Missouri and John Lewis of Georgia, all Democrats.

An aide to Lewis, a leader of the civil rights movement in the 1960s, said that as he walked to the Capitol, Lewis was called racial slurs. A spokesman for Cleaver said that a protester spat on the congressman as he was walking to the Capitol for a vote.

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